Reversible T-wave inversion -- it reverses, then evolves, then reverses when ischemia is gone. Normalization of T-waves, NOT ps
Posted Aug 27 2011 11:33am
A 62 yo male has had chest pain with exertion for 2 weeks. He began having chest pain at rest at 2AM, and presented at 7 AM.
Here is his initial ECG
Sinus rhythm. There is a QS-wave in V2 (old MI?) and very subtle terminal T-wave inversion in V3, and ST depression in V4-V6, highly suspicous for LAD NonSTEMI. I believe the extra wave in V1-V3 is artifact.
There is a PVC, but now the terminal T-wave inversion is gone. Some ST depression in V5 and V6 remains.
Now there is classic biphasic terminal T-wave inversion (strictly speaking, it is not Wellens' because Wellens' requires preservation of R-waves). There is also subtle new Terminal T-wave inversion in aVF ("inferior Wellens").
There is evolution of anterior T-waves, with T-wave inversion in V4 more pronounced now. T-wave in aVF is now upright.
On day 3, he had the LAD stented. Troponins bumped to 3.0 mcg/L after the PCI. This was recorded the next AM:
Now, the anterior T-waves have completely normalized.
Here is his initial ECG
On day 3, he had the LAD stented. Troponins bumped to 3.0 mcg/L after the PCI. This was recorded the next AM: